Prosthetics and Orthotics International最新文献

Background: Recent fused deposition modeling (FDM) technology could offer accessible socket fabrication and resolve conventional fabrication issues. However, the printing orientation in FDM affects the structural integrity and reliability.Objective:To examine the effect of printing orientation on the structural strength of 3D-printed sockets using FDM.Study Design:Experimental study of 3D-printed socket at different printing orientations in static and cyclic loadings.

Methods: This study scanned residual limbs of 2 transtibial amputees weighing 53 kg (P4) and 125 kg (P6) to create 3D-printed prosthetic sockets using FDM. Ten sockets of a P4 amputee were printed at various orientations from 0° to 90° for a structural static test. In addition, 6 sockets of the P6 amputee were printed at 90° for static and cyclic tests according to ISO 10328.

Results: Based on the results, sockets printed at 0° and 90° for the P4 amputee exceeded static ultimate force under condition I according to ISO 10328 standards with 4880 N and 4430 N, respectively. Sockets at 30°, 45°, and 60° failed before the minimum force requirement was reached. Further validation of the 90° printed socket passed the static test in conditions I and II, and the cyclic test in condition II, enduring 3 million cycles without failure.

Conclusion: The 0° and 90° printing orientations are recommended for their superior mechanical properties, whereas other orientations may pose safety risks because of insufficient structural strength. These findings could contribute to developing more reliable and durable prosthetic sockets that meet ISO 10328 standards to enhance the quality of life for amputees.

Positive model rectification is a key factor in providing a comfortable and successful transtibial prosthetic socket fitting. This study aimed to assess whether a 4% compression value in 3- and 5-mm thickness affordable ethylene-vinyl acetate roll-on (AERO) liners yields acceptable comfort and pressure distribution for transtibial prosthetic users. Stump socks were used to adjust volume in the fitting process with a socket compressed to 4%, and pressure data were collected using 6 force-sensing resistor (FSR400) sensors placed in areas sensitive and tolerant to pressure. Peak pressure was collected from 40 steps, and pressure uniformity was calculated using the coefficient of variation in 2-min walking on the treadmill. The socket comfort score was collected after the trial. Appropriate compression values, pressure distribution, and socket comfort score were analyzed using Wilcoxon signed-rank tests, and effect size was determined using Cliff's delta. The study found that a 4.95% compression was optimal for a 3-mm thickness liner, whereas a 4.5% compression suited a 5-mm liner better for comfort. Moreover, the study observed a small similarity in pressure distribution between liners, as indicated by Cliff's delta, with the 5-mm liner possibly providing more even pressure because of its thickness. Despite being made of the same material, liners with different thicknesses distribute pressure differently. Therefore, this study suggests that a 4% universal compression value in the affordable ethylene-vinyl acetate roll-on liner may be effective for use in a clinical setting. Future studies should include more participants to identify the appropriate compression for a variety of residual limbs.

Background: In many cases, individuals with lower limb amputation become less active because of impaired balance and stability and increased risk of falling. Microprocessor knees (MPKs) have been shown to reduce the risk of falls, improve balance, and increase function, evaluated with self-reported scales and questionnaires. This study aims at investigating whether the patient-reported improvements are reflected in objective physical activity (PA) parameters estimated from actimetry sensors and assess the short-term provision of an MPK.

Study design: Transfemoral amputee patients (n=29) undertaking an MPK trial at 2 prosthetic centers in the South of England were recruited for this study. Self-reported and functional test outcomes (Activities Balance Confidence, Reintegration of Normal Living Index, Prosthesis Evaluation Questionnaire scores, and 2-min walk test) were obtained before and after (4 weeks) the provision of the MPK. Activity levels were recorded over 7 consecutive days pre- and post-MPK.

Results: Self-reported scores and function test outcomes showed a general improvement in most of the patients after the provision of the MPK, with a statistically significant change (p < 0.05) in Activities Balance Confidence, Reintegration of Normal Living Index, Prosthesis Evaluation Questionnaire scores, and 2-min walk test. By contrast, the activity-based parameters estimated from actimetry showed no statistically significant changes (p > 0.05). Associations between self-reported and functional outcomes and actimetry parameters were limited.

Conclusions: Perceived and in-clinic outcome measures improved after short-term provision of an MPK for transfemoral amputees. However, PA did not change in this cohort of patients over the study period. More longitudinal studies are needed to characterize the impact of MPK provision on PA and societal participation.

Background: Rehabilitation of persons with lower limb loss generally report on outcome measures related to gait and mobility, but little is known how an inpatient exercise intervention influences health-related quality of life (HRQoL).

Objective: This study compared the effect of a 4-week rehabilitation intervention (INT) on the HRQoL of new (NEW) prosthetic users that received their prosthesis at the inpatient facility (NEW-INT) to experienced prosthetic users with several previous inpatient stays (EXP-INT).

Study design: Nonrandomized intervention trial.

Methods: In this nonrandomized intervention trial, the NEW-INT completed the EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) questionnaire at Admission, when they became Independent in walking and at Discharge. The EXP-INT completed the questionnaire at Admission and Discharge. A control group of experienced prosthetic users (EXP-CON) not partaking in the intervention completed the EQ-5D-5L questionnaire at 4-week intervals. The participants health state was recorded at all time points using a visual analog scale (EQ-VAS). An EQ-index was calculated based on the 5 dimensions of the EQ-5D-5L.

Results: At Admission, the EQ-index score of the NEW-INT (n = 18) was significantly lower compared to the EXP-INT (n = 19) (P = 0.014). The NEW-INT improved the median [interquartile range] EQ-index scores significantly from Admission to Discharge; 0.23 [0.55] vs. 0.73 [0.20], P = 0.001, whereas the EXP-INT showed no change from Admission to Discharge; 0.71 [0.23] vs. 0.65 [0.26]. At Discharge, the EQ-index scores of the NEW-INT and EXP-INT were similar. Only the NEW-INT showed significant improvements in the mean ± standard deviation EQ-VAS values from Admission (55.8 ± 20.2) to Discharge (66.4 ± 15.7), P = 0.018. The mobility dimension was the most responsive EQ-5D-5L dimension but improved significantly only for the NEW-INT from Admission to Discharge (P = 0.001). For the EXP-CON (n = 19), there were no significant changes from Test 1 to Test 2.

Conclusion: Four weeks of inpatient rehabilitation improves HRQoL in new, but not experienced prosthetic users.

Background: Over 52% of people who use a lower-limb prosthesis fall once every year, but fall risk is still not effectively screened. Few studies have identified clinical outcome measures that could help screen fall risk. Gait asymmetries between the intact and prosthetic limbs could also potentially help identify fall risk, based on findings in people with stroke. However, no studies have examined the relationship between gait asymmetries and falls in people who use a lower-limb prosthesis. Therefore, we sought to determine if any gait asymmetry parameters could significantly distinguish 12-month retrospective fallers from nonfallers.

Methods: People were recruited from private practice and the Amputee Coalition National Conference. Participants completed a 12-month retrospective fall history and 7 clinical outcome measures, as well as level-ground walking at self-selected pace with wearable sensors that collected kinematic (sagittal plane: hip, knee, and ankle range of motion) and kinetic (peak braking and propulsion ground reaction force) data.

Results: Twenty-two individuals who use a unilateral prosthesis participated (age 57.6 ± 14.2 years; 15 transtibial, 7 transfemoral). No gait asymmetry parameters significantly distinguished 12-month retrospective fallers from nonfallers. However, the Four Square Step Test did significantly distinguish fallers from nonfallers (P = 0.040, Hedge g = -0.739, area under the curve = 0.725, CI = 50-95%, cutoff time = 13.14 s), irrespective of level of prosthesis use. No parameters significantly distinguished fallers from nonfallers by level of prosthesis use (transtibial, transfemoral).

Conclusions: The Four Square Step Test cutoff time may be useful to distinguish fallers from nonfallers in unilateral lower-limb prosthesis users.

Background: Ankle foot orthoses (AFOs) improve ankle-foot stability and alignment. They might reduce the burden of care because they facilitate independent function. However, AFO use can add additional stressors such as adherence to wearing schedules and aiding with donning that might increase caregiver burden.

Objectives: The study aimed to quantify the burden experienced by family caregivers of children wearing AFOs in South Africa and to determine if there is a difference in the burden experienced by caregivers of children who have AFOs and those waiting for AFOs.

Study design: A cross-sectional survey was done in 4 South African provinces.

Methods: One hundred and twenty-three caregivers were identified through consecutive sampling. They completed the Burden Scale for Family Caregivers between March and June 2023. Descriptive and comparative analysis (χ2 test and Pearson correlation coefficient) were done.

Results: Eighty-three (67.48%) children had an AFO, whereas 40 (32.52%) needed one. The mean caregiver burden score for caregivers of children with AFOs was 21.82/60 (standard deviation 6.49), and for caregivers of children needing AFOs was 24.60 (standard deviation 5.63). Most family caregivers (69; 83.13%) of children with AFOs and children needing AFOs (32; 80.00%) experienced no to mild levels of burden. The difference in burden experienced by the 2 groups was not statistically significant (P = 0.671082).

Conclusions: Caregivers of children who can walk and use AFOs experience low to moderate levels of burden. AFOs did not reduce the caregiver burden statistically. However, clinically the burden experienced by caregivers was reduced.

Background: Ankle proprioception deficit is a major factor causing balance dysfunction in subacute stroke survivors. However, there is still no commonly-agreed ankle proprioception evaluation method for these patients. Whether ankle proprioception tested by the active movement extent discrimination apparatus (AMEDA) when participants are standing (AMEDA-standing) or sitting (AMEDA-sitting).

Objectives: This study aimed to investigate the variations in ankle proprioception measures between the AMEDA-standing and AMEDA-sitting in subacute stroke survivors and assess the test-retest reliability of these measures.

Study design: This study analyzes sitting and standing proprioception (AMEDA scores) and their associations with static/dynamic balance in 24 subacute stroke patients using ANOVA, Pearson's correlation, and ICC analyses in SPSS 26.

Methods: The battery of tests administered included the AMEDA, the Timed Up and Go Test, the Single-leg Stance, and the Limit of Stability, as measured by the NeuroCom® Balance Manager® VSRTM. Pearson correlation was applied to discern the relationship between the acuity of ankle proprioception and balance. The intraclass correlation coefficient was used to gauge the test-retest reliability of the measures. Furthermore, an analysis of variance was conducted to scrutinize any differences between the proprioception scores obtained from the AMEDA-standing and AMEDA-sitting protocols.

Results: Area under the curve values for the AMEDA-sitting during the initial test and retest were 0.665 (0.090) and 0.665 (0.080), respectively. For the AMEDA-standing, the area under the curve values were 0.697 (0.069) for the initial test and 0.699 (0.075) for the retest. Evaluating the reliability, the intraclass correlation coefficient was calculated as 0.704 for AMEDA-sitting, while for AMEDA-standing, it was 0.752. Upon conducting a Pearson correlation analysis, a statistically significant relationship was observed between AMEDA-sitting and several balance variables: Reaction Time-affected, Endpoint Displacement-affected, Max Excursion-affected, Endpoint Displacement-unaffected, Max Excursion-unaffected, and Endpoint Displacement-back.

Conclusions: In the context of subacute stroke survivors, both AMEDA-standing and AMEDA-sitting methodologies prove to be appropriate, demonstrating commendable test-retest reliability.